Diagnosis
- Culture of the organism in Barbour-Stoenner-Kelly medium is largely a research tool. Cultures are positive only early in illness, with the organism isolated primarily from EM skin lesions.
- Polymerase chain reaction (PCR) is most useful for joint fluid, is less sensitive for cerebrospinal fluid (CSF), and has little utility for plasma or urine testing.
- Serology can be problematic because tests do not clearly distinguish between active and inactive infection. Serologic testing should be undertaken when the pt has at least an intermediate pretest likelihood of having Lyme disease.
- Two-step testing: enzyme-linked immunosorbent assay (ELISA) screening with Western blot testing in cases with positive or equivocal results. IgM and IgG testing should be done in the first month of illness, after which IgG testing alone is adequate.
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